南通市基本医疗保险结算费用及流向分析

Expenditure of Basic Medical Insurance and Its Distribution among Medical Facilities

目的:分析费用控制效果与流向变化,明确管理重点,提出政策建议。方法:用SPSS11.0和Excel软件对南通市2000—2002年基本医疗保险实际数据进行统计分析。结果:(1)参保病人费用与全国平均水平相近,低于当地平均水平;药费比例逐渐下降,费用结构基本合理。(2)“板块式”管理和“总量控制、均值管理”的支付方式近期费用控制效果较好,后期费用增速加快。(3)门诊费用控制较好,住院费用增速加快。(4)三级医院费用增速快,二级医院与社会医疗机构费用与其等级不符。(5)门诊分流合理,住院医疗过度集中于三级医院。结论:(1)基本医疗保险制度既保障了参保职工的基本医疗需求,又有较好的费用控制效果。但是由于政策效应随时间递减,应加强对费用控制策略的研究,引导病人的合理分流,科学控制费用,提高基金利用效率。(2)医疗机构面对机遇与危机,应加强质量建设,提供规范、诚信服务。(3)加强区域卫生规划,提高卫生资源利用效率。

Objective Analyzing the expenditure of basic medical insurance and its distribution among different classes of medical facilities to evaluate the effect of cost control measures so that to offer policy suggestions.Method Data was collected from the database of employee's medical insurance in Nantong City from 2000to 2002 and analyzed by SPSS11.0 and Excel.Result (1)The medical expenditure of insurants was close to the national average level,while it was below the local average level.The proportion of drug expenditure was declining gradually and the interior structure of cost was rational on the whole.(2)‘Block management'and the payment method of `gross budget and mean value control'have got good effect on reducing the medical cost in the near time when the policies was executed ,and then risen rapidly again later.(3)Outpatient cost control was more effective than that of inpatient.(4)cost of third-class hospital increased faster than other medical facilities.(5)Outpatient expenditure distribution among medical facilities was rational,however,most of inpatien expenditure pooled to the third-class hospitals.Conclusion (1)The basic medical insurance scheme has ensured employee’s essential medical demands,and has pretty effect of cost control as well.But better cost control strategies must be explored so that to lead more rational flowing of insurance fund and make fund utilization great efficiency.(2)To face chance and crisis,hospitals must enhance quality and provide honest and sincere medical service.(3)To implement regional health programming to improve resource utilization efficiency.